Reebok 2009

Clinical debriefingClinical debriefingKurt WilsonKurt Wilson

Intended learning outcomes

Use clinical debriefing to deliver teaching, learning and assessment

Enhance reflective practice

Gain greater two-way feedback through clinical debriefing

Intended learning outcomes

‘Miseducation’

MiseducationMiseducation

Do students learn as intended in community?

The GP - Good

The GP - Good

The GP - Good

The GP – Not so good

The GP – Not so good

The GP – Not so good

What is meant by “clinical debriefing”

Case presentation

History Examination Investigations

Margin hypothesis Best test?Examination first

Debate and discussion

Tutor led Student led

What might students get out of it?

… very useful to learnfrom fellow students…

…very good as interactive and varied…

…topic discussion was particularly

useful as the group were able to address learning objectives not raised

in PBL

…feedback was constructiveand very encouraging… …I felt like I was applying my

knowledge & this simulates what will happen later in ‘real life’

Where does it happen at the moment?

Aims and objectivesAims and objectivesStudents will use debrief sessions to:Students will use debrief sessions to:– Learn through their own and each other’s clinical experienceLearn through their own and each other’s clinical experience

– Develop presentation, communication, examination and Develop presentation, communication, examination and therapeutic skillstherapeutic skills

– Practice record keepingPractice record keeping

– Discuss ethical issuesDiscuss ethical issues

– Prepare for future undergraduate assessmentPrepare for future undergraduate assessment

Session overviewSession overviewGroups of 8 studentsGroups of 8 students

2.5 hours long2.5 hours long

Case presentations Case presentations

DiscussionDiscussion

Self directed learning, reflection and teamworkSelf directed learning, reflection and teamwork

Use of generic techniques and structured sessionsUse of generic techniques and structured sessions

Subsequent sessionsSubsequent sessionsImproving history taking/presentation/group interaction Improving history taking/presentation/group interaction and case discussionand case discussion– Ideas, concerns, expectationsIdeas, concerns, expectations– Margin hypothesis generationMargin hypothesis generation– Examination findings firstExamination findings first– Best test?Best test?

– Sensitivity and specificitySensitivity and specificity

Structure sessionsStructure sessions

Role play

Case presentation

Use some skills to enhance active learning

Case one

Margin hypothesis generation

Margin hypothesis generation

Differential diagnosis Generation

Ranking

Discussion

“Bigger picture”

Case two

Examination findings first

Examination findings first

Understand importance of patient historyFew clues from examination?

List of diagnoses and uncertainties large?

“Bigger picture”

Case three

Best test?

Best test?

Only allowed one testWhich one and why?

Specificity (false positives?)

Sensitivity (false negatives?)

Positive and negative predictive values

Summary of cases

Topics for discussion

Issues surrounding patient centred care

Treating individuals versus population medicine

Disclosure, recommendation and understanding

Feedback

How might clinical debrief aid the process of feedback between student and tutor?

Are there any of these techniques that might help you to facilitate learning when students present cases to you?